ABSTRACT:The risks and benefits of any health care intervention are valued differently by stakeholders. One of the ethical imperatives of patient-centered care is the balanced, evidence-based presentation of risks and benefits by providers to patients. Using the example of musculoskeletal surgery with devices, we advocate the use of shared decision-making tools and processes known to improve knowledge, adjust unrealistic expectations, and elicit values about benefits desired and the degree of acceptable risks for individual patients. We describe feasibility and efficacy within our organization and address ways to foster the further adoption of this approach. [Health Affairs 26, no. 3 (2007): 726-730; 10.1377/hlthaff.26.3.726] W i t h a n y s u r g e r y, consent must be obtained from each patient, and valid consent is based on knowledge of the options, the risks and benefits of each option, and the likelihood that these will occur for the individual patient. The legal doctrine and requirements of informed consent are well known. 1 In theory, informed consent is a process, not a moment in time. In reality, it occurs when a clinician requests a patient's signature to authorize that a specific treatment or procedure take place, and the patient signs. In current practice, there is no requirement that shared decision making occur before the signing of the consent form.Not all surgery decisions lend themselves equally to the elicitation of values and preferences. For treatment recommendations that are based on guidelines or standards of care, where there is strong evidence of a treatment's effectiveness and strong agreement among patients that these are valued interventions (for example, surgery for hip fracture), the patient tends to agree to a recommendation instead of engaging in shared decision making. However, many surgeries are elective and fall under the category of preference-and values-sensitive treatment decisions. Assessing the risk/benefit trade-offs in such decisions is best done using a shared decision-making model.
Shared Decision Makingn Essential components. The process of shared decision making is a collaboration between clinician and patient, using a decision aid as an adjunct. 2 The incorporation of shared decision-making tools and the elicitation of patients' values and preferences into the traditional but obsolete surgery consent process is 7 2 6 M a y / J u n e 2 0 0 7 P e r s p e c t i v e